Activity-based Therapy Research Articles

Aerobic Exercise Versus Plyometrics in Reducing Anxiety Levels in College Students With Mild Generalized Anxiety Disorder.

Background Generalized anxiety disorder is one of the most prevalentmental disorders, characterized byexcessive anxiety and worry that affectboth mental and physical health. These pervasive illnesses have a crippling effect on people's everyday lives, quality of life, and wellness and are also highly linked with cardiovascular risk factors. Physical activity-based therapies have shown promising effects in treating a range of mental disorders, from psychosis to dementia. Out of many conventional therapies, aerobic exercise and plyometrics have been found to be effective in reducing anxiety levels. Aim This study aims to compare the effectiveness of aerobic exercise and plyometrics in reducing anxiety levels in college students with mild generalized anxiety disorder. Materials and methods A total of 96 subjects were selected for the studyusing a stratified sampling technique;48 subjects were assigned to the aerobic exercise group (Group A) and 48 to the plyometric group (Group P). Randomization was done using the sealed envelope method. This study includes students aged 18-25 years, both genders, with a body mass index of <30, a Beck Anxiety Inventory (BAI) score of 8-15, and at least six months without practicing any kind of physical activity. The exclusion criteria are subjects with other psychotic disorders, a history of cardiovascular disease, chronic kidney disease, inflammatory disease, malignant conditions, neurological disorders, anemia, with comorbid conditions, who were involved in supportive therapy for anxiety such as cognitive behavioral therapy, use of anxiolytic drugs, females with menstrual disorders, and subjects with recent trauma or injuries (fracture, ligament sprain, or muscle strain). The treatment duration for both groups was three days per week for a total of four weeks. Group A consists of five minutes of warm-up, 30 minutes of walking, and five minutes of cool-down, for a total of 40 minutes. Group P consists of warm-up of five minutes, high knees, single leg hop and jump squats of two sets and 10 repetitions for 30 minutes, and a cool-down of five minutes, for a total of 40 minutes. Conclusion The anxiety levels were analyzed using the BAI, revealing that bothgroups have shown improvements in Beck anxiety scores; however,Group A has shown a comparatively more significant improvement than Group P.

Transcutaneous Electrical Spinal Cord Stimulation Increased Target-Specific Muscle Strength and Locomotion in Chronic Spinal Cord Injury.

The recovery of locomotion is greatly prioritized, and neuromodulation has been emerging as a promising approach in recent times. Single-subject research design. A laboratory at The Hong Kong Polytechnic University. To investigate the effects of augmenting activity-based therapy (ABT) to transcutaneous electrical spinal cord stimulation (TSCS) on enhancing specific lower limb muscle strength and improving locomotor ability in an individual with chronic incomplete spinal cord injury (iSCI). An individual with iSCI underwent two phases of treatment, ABT alone followed by combined ABT+TSCS, each for a period of 10 weeks. The TSCS stimulated T10-T11 and T12-L1 segments with a frequency of 30 Hz at an intensity between 105 mA and 130 mA. Manual muscle testing, 6 min walk test (6MWT), and surface electromyography (EMG) responses of specific lower limb muscles were measured. Additionally, spasticity and sensorimotor examinations were conducted every two weeks, while pain tolerance was recorded after each treatment session. After the ABT+TSCS treatment, there was an increase in overall muscle strength grading (from 1.8 ± 0.3 to 2.2 ± 0.6 out of 5.0). The 6MWT showed a greater increase in walking distance (3.5 m to 10 m) after combined treatment than ABT alone. In addition, the EMG response of the anterior rectus femoris, biceps femoris, medial gastrocnemius, and tibialis anterior after ABT+TSCS increased more than after ABT alone. The spasticity grade was reduced (from 0.8 ± 0.7 to 0.5 ± 0.6) whereas the average lower limb motor score increased from 17 to 23 points. No adverse effects were reported. ABT+TSCS increased the target-specific lower limb muscle strength and walking ability more than ABT alone in an individual with chronic iSCI.

A Systematic Review: Exercise Based Approaches to Activate Central Pattern Generator in Spinal Cord Injury Survivors

&amp;lt;i&amp;gt;Background: &amp;lt;/i&amp;gt;Locomotion is a basic motor act which is essential for the survival of humans. The basic muscle synergies which are responsible for body propulsion are generated by the neurons in spinal cord collectively known as Central Pattern Generator for Locomotion. Spinal Cord is the major conduit for the transmission of information between brain and the rest of the body. Injury to the spinal cord is the insult to the neural elements of the spinal canal from foramen magnum to cauda equina. SCIs are heterogeneous in casualty, severity and location of injury but locomotion is the ultimate goal for the post-SCI survivors. In order for locomotion to occur, a complex CPG center of locomotion activation is required. Exercise based approach is the cornerstone in the treatment and management of individuals with SCI.&amp;lt;i&amp;gt; Objective&amp;lt;/i&amp;gt;: To study the existing evidence on the effectiveness of Exercise-based approaches to activate Central Pattern Generator in Spinal Cord Injury Survivors with a focus on randomized controlled trials and cross over trials studies. &amp;lt;i&amp;gt;Methodology&amp;lt;/i&amp;gt;: Literature published in English language. Original publications including RCTs and cross over trials published in peer-reviewed journals focused on traumatic or non-traumatic spinal cord injury published from 2014 to 2022. A key literature search adopted, for a more targeted search the following terms were used: effect of exercise, task-based approaches, body weight supported treadmill training, over ground training, balance and coordination training on the activation. &amp;lt;i&amp;gt;Search Strategy&amp;lt;/i&amp;gt;: Database used were PubMed, Cochrane, Scopus, EMBASE, CINAHL and Medline. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: Assessment of Risk of Bias was done using PeDro analysis. Eleven studies met the inclusion criteria out of 300 studies searched. &amp;lt;i&amp;gt;Discussion&amp;lt;/i&amp;gt;: Exercise based approaches are highly essential and integrated part of the rehabilitation of spinal cord injury survivors. It has been concluded that activity-based therapies are highly effective but under-utilized by the rehabilitation specialists.

Implementing Activity-Based Therapy for Spinal Cord Injury Rehabilitation in Canada: Challenges and Proposed Solutions.

Activity-based therapy (ABT) is a therapeutic approach with multiple benefits including promoting neurorecovery and reducing the likelihood of secondary complications in people living with spinal cord injury (SCI). Barriers and facilitators to ABT implementation for SCI rehabilitation have been studied from various perspectives through qualitative research. However, these viewpoints have not been synthesized to identify challenges of and strategies for implementing ABT across the Canadian healthcare system. Thus, the purpose of our study was to examine the current state of ABT in Canadian healthcare settings according to users' perspectives. Our main objectives were to compare barriers and facilitators to ABT implementation across Canadian healthcare settings according to users' perspectives and to identify optimal intervention strategies for ABT delivery across the Canadian healthcare system from acute to community care. We searched Scopus, CINAHL, OvidMedline, and other sources. Eligible articles were qualitative or mixed methods studies exploring ABT for adults with SCI in a Canadian healthcare setting. We analyzed qualitative findings through a thematic synthesis followed by a deductive content analysis. The Mixed Methods Appraisal Tool was used for critical appraisal. Nine articles were included. The thematic synthesis revealed two main themes: (1) factors influencing acceptance and adaptation of ABT across healthcare settings in Canada and (2) proposed solutions. The deductive analysis applied the Behaviour Change Wheel (BCW) to identify limited components of behaviour and appropriate interventions. To address ABT implementation challenges across the Canadian healthcare system, evidence-based interventions should target BCW subcategories of reflective motivation, social opportunity, and physical opportunity.

Exploring knowledge and implementation gaps of activity-based therapy in centers lacking specialized spinal cord injury services: understanding therapists’ perspectives

Study designQualitative exploratoryObjectivesRehabilitation following spinal cord injury (SCI) is a life-long process involving healthcare in a variety of settings, including facilities lacking SCI-specific services (i.e., non-SCI-specialized centers). Activity-based therapy (ABT) is a neurorestorative approach involving intensive, task-specific movement practice below the injury level. This study explored the existing knowledge, perceptions, and implementation of ABT among physical and occupational therapists working in non-SCI-specialized centers.SettingCanadian hospitals and community clinicsDesign/methodsSemi-structured interviews were conducted with Canadian therapists who worked at non-SCI-specialized centers and treated at least one patient with SCI within the last 18 months. The Theoretical Domains Framework was used to develop interview questions that queried therapists’ experiences in delivering SCI rehabilitation, their understanding of ABT and experience with its implementation. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description.ResultsFour physical therapists and three occupational therapists, from diverse settings (i.e., acute care, inpatient rehabilitation, long-term care, outpatient rehabilitation, rural outpatient clinic) participated. Three themes were identified: (1) Available knowledge, resources and therapy time in non-SCI-specialized centers challenge ABT implementation, (2) How current therapy practices in non-SCI-specialized centers align with ABT and (3) Desire for ABT knowledge. Although participants were not familiar with the term ABT, it was identified that they were unknowingly incorporating some components of ABT into their practice. Participants expressed a keenness to learn more about ABT.ConclusionCurrent knowledge and implementation of ABT in non-SCI-specialized centers is limited. Tailoring ABT education to therapists at non-SCI-specialized centers may increase ABT implementation.

Ab. No. 95 Integrated Effect of Photobiomodulation Therapy Along With Surface Spinal Stimulation and Activity-Based Therapy on Locomotion in an Individual With Traumatic Incomplete Spinal Cord Injury - Single Case Study

Introduction: The purpose of the study was to examine the integrated effect of photobiomodulation therapy (PBMT) along with surface spinal stimulation (SSS) and activity-based therapy (ABT) on the locomotion in an individual with traumatic incomplete spinal cord injury (SCI). The study aims to provide an insight for advanced non-invasive treatment approach useful in activating central pattern generator by bio-modulating the state of spinal cord. Methods: Individual diagnosed with traumatic spinal cord injury, Motor incomplete ASIA grade B. A 36-year-old male pre-diagnosed with D12-L1 vertebrae fracture and anterolisthesis of D11 over D12 vertebra had undergone surgical management in august 2023. Physiotherapy management was given with PBMT using Class IV LASER (2000 joules at 7 watts) on lesion site, SSS (2500 Hz carrier frequency, 80 Hz beat frequency for 20 minutes) on paravertebral area and activity-based therapy (trunk control exercises, body weight supported treadmill training, overground walking for 45 minutes) for 6 sessions per week for duration of 5 weeks. Pre and Post intervention assessment was done using International Standards for Neurological Classification of Spinal cord injury- ASIA Impairment Scale, Walking Index for spinal cord injury-II (WISCII-II) and Spinal cord independence measure-III (SCIM-III) at day 0, 15 and 30. Results: ASIA motor score of right lower limb, SCIM-III and WISCI-II had shown significant improvement. ASIA motor score of right lower limb improved from 0 to 1, SCIM-III from 42 to 54 and WISCI-II from 0 to 6 between day 0 and day 30. Conclusion: The study concluded that combined photobiomodulation therapy using class IV LASER along with surface spinal stimulation and activity-based therapy has positive effect in enhancing the locomotion in an individual with traumatic incomplete SCI. Implications: This integrated non-invasive treatment approach can be used as management guideline for enhancing locomotion in individuals with incomplete SCI.

Monitoring muscle activity in pediatric SCI: Insights from sensorized rocking chairs and machine-learning.

Introduction: Activity-based therapy is effective at improving trunk control in children with spinal cord injury. A prototype sensorized rocking chair was developed and confirmed as an activity that activates trunk muscles. This study uses data collected from the chair to predict muscle use during rocking. Methods: The prototype rocking chair included sensors to detect forces, accelerations, as well child and chair movement. Children with spinal cord injury and typically developing children (2-12years), recruited under an approved IRB protocol, were observed rocking while sensor and electromyography data were collected from arm, leg, and trunk muscles. Features from sensor data were used to predict muscle activation using multiple linear regression, regression learning, and neural network modeling. Correlation analysis examined individual sensor contributions to predictions. Results: Neural network models outperformed regression models. Multiple linear regression predictions significantly correlated (p < 0.05) with targets for four of eleven children with SCI, while decision tree regression predictions correlated for five children. Neural network predictions correlated for all children. Conclusions: Embedded sensors capture useful information about muscle activation, and machine learning techniques can be used to inform therapists. Further work is warranted to refine prediction models and to investigate how well results can be generalized.

Activity-Based Therapy for Mobility, Function and Quality of Life after Spinal Cord Injuries-A Mixed-Methods Case Series.

(1) Background: Despite inconclusive evidence on the benefits of activity-based therapies (ABTs) in people with spinal cord injuries, implementation has occurred in clinics worldwide in response to consumers' requests. We explored the clinical changes and participants' perceptions from engaging in an ABT program in the community. (2) Methods: This mixed-methods study involved a pragmatic observational multiple-baseline design and an evaluation of participants' perceptions. Fifteen participants were included. Outcome measures were balance in sitting using the Seated Reach Distance test, mobility using the Modified Rivermead Mobility Index and quality of life using the Quality of Life Index SCI version pre- and post-participation in an ABT community-based program. Linear mixed models and logistic regressions were used to analyse the effects of intervention. Semi-structured interviews explored participants' perceptions using inductive thematic analysis. (3) Results: There was an increase of 9% in the standardised reach distance (95% CI 2-16) for sitting balance, 1.33 points (95% CI: 0.81-1.85) in mobility and 1.9 points (0.17-2.1) in quality of life. Two themes emerged from the interviews: (1) reduced impact of disability and an increased sense of life as before, and (2) the program was superior to usual rehabilitation. No adverse events related to the intervention were observed. (4) Conclusion: ABT delivered in the community improved clinical outcomes in people with a chronic SCI. High levels of satisfaction with the program were reported.

Providing Insights into the Challenges of Implementing Activity-Based Therapy in Canada: A Comparative Analysis Using Focus Group Interviews with Key Interest Groups.

Activity-based therapy (ABT) has emerged as a therapeutic approach that may promote neurorecovery and reduce secondary complications in people living with spinal cord injury or disease (SCI/D). In spite of the numerous health benefits, adoption of ABT into practice has been limited across the Canadian care continuum. This study aimed to understand the challenges of implementing ABT in Canada for people living with SCI/D through the perspectives of key interest groups. Researchers, hospital therapists, community trainers, administrators, persons living with SCI/D, and advocates, funders, and policy experts who had knowledge of and/or experience with ABT participated in focus group interviews to share their perspectives on the barriers to ABT practice. Interviews were analyzed using conventional content analysis followed by a comparative analysis across groups. The 48 participants identified six key challenges: (1) challenge of gaps in knowledge/training, (2) challenge of standardizing ABT, (3) challenge of determining the optimal timing of ABT, (4) challenge of defining, characterizing, and achieving high dosage and intensity, (5) challenge of funding ABT, and (6) challenge of measuring participation and performance in ABT. A comparative analysis found some challenges were emphasized by certain groups, such as the cost of ABT for persons with SCI/D, lack of education and training in ABT for therapists and trainers, minimal evidence to develop guidelines for researchers and advocates, and funding ABT programs for administrators. Participants highlighted several challenges that limit ABT practice. Strategies to address these challenges will support successful implementation of ABT in Canada.

Advances in Stroke Neurorehabilitation.

Stroke is one of the leading causes of disability worldwide despite recent advances in hyperacute interventions to lessen the initial impact of stroke. Stroke recovery therapies are crucial in reducing the long-term disability burden after stroke. Stroke recovery treatment options have rapidly expanded within the last decade, and we are in the dawn of an exciting era of multimodal therapeutic approaches to improve post-stroke recovery. In this narrative review, we highlighted various promising advances in treatment and technologies targeting stroke rehabilitation, including activity-based therapies, non-invasive and minimally invasive brain stimulation techniques, robotics-assisted therapies, brain-computer interfaces, pharmacological treatments, and cognitive therapies. These new therapies are targeted to enhance neural plasticity as well as provide an adequate dose of rehabilitation and improve adherence and participation. Novel activity-based therapies and telerehabilitation are promising tools to improve accessibility and provide adequate dosing. Multidisciplinary treatment models are crucial for post-stroke neurorehabilitation, and further adjuvant treatments with brain stimulation techniques and pharmacological agents should be considered to maximize the recovery. Among many challenges in the field, the heterogeneity of patients included in the study and the mixed methodologies and results across small-scale studies are the cardinal ones. Biomarker-driven individualized approaches will move the field forward, and so will large-scale clinical trials with a well-targeted patient population.

Student Competition (Knowledge Generation) ID 1975184

Background/Objectives Implementing activity-based therapy (ABT) across the continuum of care in Canada has proved challenging. The objective of this study was to understand and compare multi-group perspectives on the challenges that hinder implementation of ABT in Canada for people living with spinal cord injury or disease (SCI/D). Methods Individuals from six key interest groups (i.e., researchers; persons living with SCI/D; administrators; physical and occupational therapists; community-based exercise trainers; and funders, advocates, and policy experts) who had knowledge of and/or experience with ABT were recruited to participate in focus group interviews that were held over web conferencing. Participants were asked about the barriers and facilitators to practicing ABT. Interview transcripts were analyzed using conventional content analysis followed by a comparative analysis across groups. Results Forty-eight individuals participated in interviews lasting 30-80 minutes. Six themes were identified: 1) Challenge of defining ABT and addressing gaps in knowledge/training. 2) Challenge of standardizing ABT. 3) Challenge of determining the optimal timing of ABT. 4) Challenge of defining, characterizing and achieving high dosage and intensity. 5) Challenge of funding ABT. 6) Challenge of measuring participation and performance in ABT. While all groups acknowledged these six challenges, therapists and community trainers viewed knowledge/training gaps and achieving high dosage and intensity as key challenges. Researchers and advocates emphasized funding as a key challenge. Conclusion Participants highlighted the challenges that limit adoption of ABT into practice within hospital and community settings. Future research should explore avenues to address these challenges to support successful implementation of ABT in Canada.

Student Competition (Clinical/Best Practice Implementation) ID 1974598

Background/Objective Rehabilitation after spinal cord injury (SCI) is a life-long process with individuals accessing care in a variety of settings, including centres without SCI-specific services (i.e., non-SCI-specialized centres). Activity-based Therapy (ABT) is a relatively new neurorestorative approach that involves intensive, task-specific movement practice below the level of injury. This study aimed to understand current knowledge, perceptions, and use of ABT by physical and occupational therapists at non-SCI-specialized centres. Design/Methods A qualitative exploratory study using semi-structured interviews was conducted. The Theoretical Domains Framework was used to develop an interview guide that queried therapists’ experiences providing SCI rehabilitation, perceptions of ABT and ABT implementation. Canadian therapists who worked with at least one SCI patient in the last 18 months and practiced at non-SCI-specialized centres participated. Interviews were audio-recorded, transcribed verbatim and analyzed using interpretive description. Results Four physical and three occupational therapists from acute, inpatient, long-term care and outpatient settings participated. Three themes were determined: 1) Perceived challenges of working with SCI in non-SCI-specialized centres, 2) Current therapy techniques used and 3) Desire for ABT knowledge and implementation strategies specific to non-SCI-specialized centres. It was identified that participants were unknowingly incorporating some components of ABT in their practice. Participants emphasized challenges to ABT implementation, such as knowledge gaps, and expressed a keenness to learn more about ABT. Conclusions Current implementation of ABT in non-SCI-specialized centres is limited, with a variety of challenges and therapist needs identified. Tailoring ABT education to therapists at non-SCI-specialized centres may increase implementation of ABT at these centres.

Workshop (Clinical/Best Practice Implementation) ID 1984795

Background/Objectives Following an initial summit in March 2019, various Canadian stakeholders have collaborated within a Community of Practice (CoP) with a vision to increase the access to, and quality of activity-based therapies (ABT) for persons with spinal cord injury/disease (SCI/D). This workshop will describe key knowledge products and study findings emanating from working groups of the ABT CoP as well as a study initiated through the Canadian SCI Standing and Walking Module Group. Design/Methods Priority areas were identified by consensus across the ABT CoP, leading to several studies and development of specific knowledge products. Key challenges included defining and standardizing ABT, gaps in knowledge/training and practice variation with a focus on achieving optimal timing, dosage and intensity of ABT. Various knowledge products and study findings related to these challenges will be presented, with audience interaction encouraged through polls and open discussion. Results Presentation highlights include a framework for structured reporting of ABT and a series of videos, pod-casts and information cards promoting ABT. In addition, a mixed methods study of Canadian physiotherapists demonstrated that ABTs were a much desired, yet not fully available treatment option. Therapists identified needs for more fulsome research partnerships, improved and more creative staffing models, enhanced training methods and the importance of a strong therapeutic alliance. Conclusion The work of the ABT CoP will continue to focus on these and other priorities, with the ultimate goal of universal access and identification of approaches that will enhance outcomes for persons with SCI/D.

Workshop (Clinical/Best Practice Implementation) ID 1972517

Background/Objectives Teams with diverse perspectives and experiences have been increasingly recognized for their ability to identify key issues and utilize creativity and problem solving to plan and implement research and clinical initiatives that lead to greater impact. Yet, often we are unsure how to best engage individuals with differing expertise, such as those with lived experience, clinicians, healthcare administrators, engineers, researchers, funders and policy experts. After completing this workshop, participants will be able to: 1) Understand the principles and value of meaningfully engaging with a diverse team when conducting research or clinical projects, 2) Identify strategies that can facilitate the meaningful engagement of individuals with differing expertise, and 3) Create a plan of engagement for a research study or clinical initiative. Methods/Overview A combination of lecture-based and case-based learning will be used to explain the guiding principles and best-practices for meaningful engagement and to discuss relevant resources, such as the North American Spinal Cord Injury (SCI) Consortium’s SCI Resource Advocacy Course and the Integrated Knowledge Translation Guiding Principles. Participants will be asked to apply these principles and practices to one of their own research or clinical initiatives through small group discussion. The Canadian Activity-Based Therapy (ABT) Community of Practice, which brings together diverse groups to address priorities for ABT research and clinical care, will be used as a case example during large group discussion. Results Not applicable. Conclusions Through this workshop, participants will gain knowledge and strategies that can be applied to facilitate meaningful engagement in research and clinical initiatives.

Tracking activity-based therapy for people living with spinal cord injury or disease: insights gained through focus group interviews with key stakeholders

Purpose The development of a tool to track participation in activity-based therapy (ABT) for people with spinal cord injury or disease (SCI/D) was identified as a priority of the Canadian ABT Community of Practice. The objective of this study was to understand multi-stakeholder perspectives on tracking ABT participation across the continuum of care. Materials and methods Forty-eight individuals from six stakeholder groups (persons living with SCI/D; hospital therapists; community trainers; administrators; researchers; and funders, advocates and policy experts) were recruited to participate in focus group interviews. Participants were asked open-ended questions concerning the importance of and parameters around tracking ABT. Transcripts were analyzed using conventional content analysis. Results Themes reflected the Who, What, Where, When, Why and How of tracking ABT. Participants described the importance of involving hospital therapists, community trainers and individuals with SCI/D in tracking ABT to capture both subjective and objective parameters across the continuum of care and injury trajectory. Digital tracking tools were favoured, although paper-based versions were regarded as a necessity in some circumstances. Conclusions Findings highlighted the importance of tracking ABT participation for individuals with SCI/D. The information may guide the development of ABT practice guidelines and support the implementation of ABT in Canada.

Neuromodulation Through Spinal Cord Stimulation Restores Ability to Voluntarily Cycle After Motor Complete Paraplegia.

Abstract Epidural spinal cord stimulation (eSCS) of the lower thoracic spinal cord has been shown to partially restore volitional movement in patients with complete chronic spinal cord injury (cSCI). Combining eSCS with intensive locomotor training improves motor function, including standing and stepping, but many patients with cSCI suffer from long-standing muscle atrophy and loss of bone mineral density, which may prohibit safe implementation. Safe, accessible, and effective avenues for pairing neuromodulation with activity-based therapy remain unexplored. Cycling is one such option that can be utilized as an eSCS therapy given its low-risk and low-weight-bearing requirement. We investigated the feasibility and kinematics of motor-assisted and passive cycle-based therapy for cSCI patients with epidural spinal cord stimulation. Seven participants who underwent spinal cord stimulation surgery in the Epidural Stimulation After Neurologic Damage (E-STAND) trial (NCT03026816) participated in a cycling task using the motor assist MOTOmed Muvi 300. A factorial design was used such that participants were asked to cycle with and without conscious effort with and without stimulation. We used mixed effects models assessing maximum power output and time pedaling unassisted to evaluate the interaction between stimulation and conscious effort. Cycling was well-tolerated and we observed no adverse events, including in participants up to 17 years post-initial injury and up to 58 years old. All participants were found to be able to pedal without motor assist, which primarily occurred when stimulation and effort were applied together (p = 0.001). Additionally, the combination of stimulation and intention was significantly associated with higher maximum power production (p < 0.0001) and distance pedaled (p = 0.0001). No association was found between volitional movement and participant factors: age, time since injury, and spinal cord atrophy. With stimulation and conscious effort, all participants were able to achieve active cycling without motor assistance. Thus, our stationary cycling factorial study design demonstrated volitional movement restoration with eSCS in a diverse study population of cSCI participants. Further, motor-assist cycling was well-tolerated without any adverse events. Cycling has the potential to be a safe research assessment and physical therapy modality for cSCI patients utilizing eSCS who have a high risk of injury with weight bearing exercise. The cycling modality in this study was demonstrated to be a straightforward assessment of motor function and safe for all participants regardless of age or time since initial injury.

Perspectives of Activity-based Therapy Practice in Canada through Focus Group Interviews with Key Interest Groups

Perspectives of Activity-based Therapy Practice in Canada through Focus Group Interviews with Key Interest Groups

Technology used in activity based therapy for individuals living with spinal cord injury across Canada

Study designCross-sectional equipment inventory.ObjectivesThe objective of this study was to describe the equipment used in activity-based therapy (ABT) programs for individuals with spinal cord injury or disorder (SCI/D) across Canada.SettingsPublicly funded and private SCI/D care settings.MethodsA survey on equipment available for ABT for different therapeutic goals was answered by Canadian sites providing SCI/D rehabilitation. Information about the setting and type of client were also collected. The survey results were compiled into an inventory of the reported types and use of ABT related equipment, with equipment grouped into varying levels of technology. Descriptive statistics and qualitative descriptive analysis were used to answer the questions: (1) ‘who’ used the equipment, (2) ‘what’ types of equipment are used, (3) ‘why’ (i.e., for which therapeutic goals), and (4) ‘how’ it is used.ResultsTwenty-two sites from eight Canadian provinces completed the survey. Reported equipment was classified into 5 categories (from low to high-tech). Most equipment reported was used to train balance. The high-tech equipment reported as available, was mostly used for walking training and strengthening of the lower limbs. Low-tech equipment was reported as being used most frequently, while high-tech devices, although available, were reported as infrequently or rarely used.ConclusionsA large spectrum of equipment with varying levels of technology were reported as available, but were inconsistently used to provide ABT interventions across sites. In order to increase the clinical use of available equipment for ABT, education tools such as protocols regarding ABT principles and implementation are needed.

Application of Electrical Stimulation to Enhance Axon Regeneration Following Peripheral Nerve Injury.

Enhancing axon regeneration is a major focus of peripheral nerve injury research. Although peripheral axons possess a limited ability to regenerate, their functional recovery is very poor. Various activity-based therapies like exercise, optical stimulation, and electrical stimulation as well as pharmacologic treatments can enhance spontaneous axon regeneration. In this protocol, we use a custom-built cuff to electrically stimulate the whole sciatic nerve for an hour prior to transection and repair. We used a Thy-1-YFP-H mouse to visualize regenerating axon profiles. We compared the regeneration of axons from nerves that were electrically stimulated to nerves that were not stimulated (untreated). Electrically stimulated nerves had longer axon growth than the untreated nerves. We detail how variations of this method can be used to measure acute axon growth.

A Scoping Review of the Characteristics of Activity-based Therapy Interventions Across the Continuum of Care for People Living With Spinal Cord Injury or Disease

To identify the characteristics of activity-based therapy (ABT) that individuals with spinal cord injury and disease (SCI/D) participate in across the continuum of care. A search of 8 databases was conducted from inception to 4 March 2020: Medline, CINAHL, Embase, Emcare, PEDro, APA PsycINFO, Cochrane Database of Systematic Reviews, and the CENTRAL. The search strategy used terms identifying the population (SCI/D) and concept (ABT). Original studies involving individuals with SCI/D ≥16 years of age participating in ABT interventions for >1 session were included in the review. The Joanna Briggs Institute guidelines for scoping reviews were followed. The initial search produced 2306 records. Title, abstract, and full-text screening by 2 independent reviewers yielded 140 articles. Data extraction was conducted by 3 independent reviewers and charted according to key themes. Data fields included participant demographics, ABT interventions, exercises, parameters, technology, and setting. Data synthesis included frequency counts and descriptive analysis of key themes. Eighty percent of participants were male. Eighty-seven percent of studies included individuals with tetraplegia (26% exclusive). Fifty-six percent of studies occurred in a research lab. Fifty-four percent of studies were single modality interventions encompassing the whole body (71%). Sixteen main types of ABT exercises were identified. The most common were treadmill training (59%), muscle strengthening (36%), and overground walking (33%). Electrical stimulation (50%) and virtual reality (6%) were used in combination with an ABT exercise. Eighty-four types of parameters were identified. Six were general intervention parameters and 78 were specific to the type of ABT exercise. Sixteen main categories of technology were reported. The most common were motorized treadmills (47%) and transcutaneous electrical stimulation (44%). The characteristics of ABT are diverse in scope. The results will inform the content to include in tools that track ABT participation and performance.